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V; <br />SAN JOAQUIN <br />COUNTY <br />Greatness grows here. <br />Environmenta�` Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date. � 1 Ins ector. � CONSTRUCTION <br />N _ <br />Facility Address: 's O <br />Well Address: <br />WP# ('� O I, <br />Soil Boring#: -r <br />Drilling Company: � <br />Driller Onsite: <br />Consultant: <br />Geologist: �h � <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: <br />cpnii � <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Well#: <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑Yes ❑No <br />72a n.� <br />Screen Length From: To: <br />�0�� Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <br />❑ Yes <br />❑ Yes <br />❑No <br />❑No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Covered: ❑Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Tot I Depth: <br />Depth to Water: � 2. <br />Grout Material: <br />Gallons of Grout Used: .�- � � �►p..,� <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation�Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity �remie <br />�� <br />❑Other: <br />Water <br />allons <br />Cemen 471b <br />ea s <br />�°�° Mix <br />Water <br />allons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />ti Bags <br />4.7 <br />Thickest <br />Thinnest <br />riBags <br />2, 5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7,5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />40 <br />80 <br />8 <br />20 <br />40 <br />8 <br />COMPLETION ❑Stove Pipe ❑Christie Box <br />casing <br />height <br />�180VE-GROUND C}-{R15TY-80X <br />COMiPLE7fON COMPLETION <br />c3<«,�d surfac. <br />procrt <br />n. <br />tt. <br />tt. <br />_ � <br />;;>� = m <br />�s;• A <br />}� = r <br />C <br />O <br />stotiQd Y _ � <br />�� -- <br />_�> — <br />Cx S � _ <br />ft. -' ft - <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Screen <br />Feet <br />BentonitefOement Mix <br />3°!° Mix <br />�°�° Mix <br />Bentonite per 47 Ib <br />1.41 <br />2.47 <br />Bentonite per 94 Ib <br />2.82 <br />4.7 <br />�, . � �. � S <br />1868 .Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � <br />10/16/2017 <br />F 209 464-0138 � www.sicehd.com <br />